Vaginal Lesions in a 7-Year-Old: Are They Signs of Sexual Abuse?

A 7-year-old girl was brought in for evaluation after her mother found a lesion on the girl’s vaginal area. The child had complained of discomfort when the mother washed her genitals; the mother then examined her, found the lesion, and took a photograph (Figure 1). The child had not complained of genital pain prior to being washed by her mother. The girl denied genital trauma or sexual abuse when the mother asked her about these. The child’s mother took another photograph of the area approximately 1 week after the lesion was discovered (Figure 2). The child presented to her pediatrician’s office for evaluation and was referred to the child abuse pediatrician due to the pediatrician’s concern for trauma.

At presentation, the child was afebrile with stable vital signs. She had no genital pain, bleeding, or discharge. A forensically informed interview was conducted with the child, during which she denied genital trauma or sexual abuse.

Findings on physical examination of the genitals showed hypopigmentation of the bilateral labia majora and perineal body. Erythematous irregular lesions were present on the inner aspect of the bilateral labia majora and the right labia minora, with a posterior labial adhesion. The hymen was contiguous and the vestibular fossa and posterior fourchette were atraumatic (Figure 3).

Are this girl’s lesions signs of child sexual abuse?

(Answer and discussion on next page)

Natalie Kissoon, MD, is an attending physician at the Center for Miracles and an assistant professor of pediatrics (clinical) at The University of Texas Health Science Center at San Antonio.

Amy Goldberg, MD, is an attending physician at the Lawrence A. Aubin, Sr. Child Protection Center at Hasbro Children’s Hospital, and an associate professor of pediatrics (clinical) at the Warren Alpert Medical School of Brown University, in Providence, Rhode Island.